J M Bourgeois

Thirty-nine consecutive patients with consolidated lung confirmed radiologically underwent sonography, and their sonograms were compared with results for 100 healthy subjects. The hyperechoic line of normal aerated lung and its air artifacts showed respiratory motions ("gliding sign," n = 100). Patients with pneumonia demonstrated distinct sonographic patterns. Strong linear echoes with characteristic air artifacts (air bronchogram) and anechoic tubular structures (fluid bronchogram) were visualized in 36 of 39 patients (92.30%). The superficial lung showed a homogeneous hypoechoic band termed "superficial fluid alveolograms" (n = 39) with respiratory motions in 35 of 39 patients. We conclude that sonography can evaluate pulmonary consolidation and may provide additional roentgenographic information, especially when fluid bronchograms are visualized.

Crohn's disease associated dysmotility has been attributed to fibrosis and damage to enteric nerves but injury to interstitial cells of Cajal (ICC) could also be involved. We assessed ICC in specimens obtained from patients with Crohn's disease and determined the relation between ICC and the inflammatory infiltrate, particularly mast cells (MC) using quantitative immunohistochemistry and electron microscopy. Ultrastructural injury to ICC was patchy in all ICC subtypes but ICC-Auerbach's plexus (AP) showed damage more frequently, i.e. swelling of mitochondria, decreased electron density, autophagosomes and partial depletion of the cytoplasm. Light microscopy confirmed a significant decrease in c-kit immunoreactivity for ICC-AP and an increased number of MC in the muscularis externa. Electron microscopy showed MC exhibiting piecemeal degranulation and making frequent and selective membrane-to-membrane contact with all types of injured ICC which suggests chronic release of granule content to affect ICC. Extent of ICC injury was not associated with duration of the disease. In conclusion, ultrastructural injury and loss of ICC-AP is evident in Crohn's disease. Epidemiological and morphological data suggest that ICC have the capacity to regenerate in spite of the chronic insult. The muscularis hosts a marked number of MC that exhibit piecemeal degranulation associated with ICC and may facilitate ICC maintenance.

Thirty-six deep hepatic lesions of localized photocoagulation were induced in 11 pigs by means of a neodymium-YAG laser. Laser applications of 80 W/10 sec (10.190 W/cm2) were transmitted through a handpiece coupled to a water-cooling circulation system to protect the quartz fiber and positioned through an echo-guided trocar. During irradiation, temperature was sufficient for vaporization up to 5 mm from the laser source and high enough for tumor cell kill at a 10-mm distance (54 degrees C/60 sec). Intraoperative ultrasound visualized increasing photocoagulation (12-18 mm), and further controls demonstrated an echo-free core of vaporization progressively covered by increasing fibrosis, well demarcated from normal parenchyma. Microscopy revealed central coagulative necrosis marginated from the third day by a growing fibrosis. By day 20 immunoblasts and mast cells were in profusion in the lesion border, and by day 120 a fibrotic network had invaded the scar and confirmed healing free of complication. This technique is proposed for deep vaporization of disseminated hepatic metastases.

When transthoracic biopsy is required for diagnosing lung diseases, radiographic procedures are the methods of choice, sonographic application being still limited. Sixty-four consecutive patients with pulmonary lesions adjacent to the chest wall underwent sonography. Findings showed hypoechoic homogeneous lesions (56 cases) with posterior regular margin (57 cases). Increasing echoes deep to the mass and sonographic interruption of hyperechoic surface were seen in all patients. In two cases, chest wall invasion had been diagnosed. Histologic diagnosis was made in 55 of the 64 patients (85.9%). Two pneumothoraces occurred. Sonography is a useful, accurate, and safe technique for diagnosing selected pulmonary lesions.

The value of sonography in lung diseases such as sarcoidosis is not established. Twelve patients with pulmonary sarcoidosis and eight control subjects underwent a sonographic examination using a high frequency probe (7.5 MHz). The normal lung surface showed smooth and regular hyperechoic patterns, respiratory motions, and occasionally minute interruptions with comet tails. All patients with sarcoidosis showed various surface abnormalities, which appeared irregular and rough with coarse interruptions, producing an increase of artifacts. Nodular patterns were found in nine of 12 patients (75%). Sonography also revealed abnormalities not diagnosed by chest radiographs (n = 2). These findings could offer an complementary approach for evaluating sarcoidosis.